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Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo

AOT Procedural Questions about Treatment Plan and Monitoring

How is the treatment plan developed?

An examining physician appointed by the local director of community services prepares the treatment plan, which is then submitted to the court. The examining physician must permit the consumer, his/her treating physician, and, if requested by the individual, a relative, close friend or other concerned individual to actively participate in the development of the treatment plan.

What services are mandatory in an AOT treatment plan?

The assignment of a care coordinator, either in the form of a case manager or ACT Team, is mandatory in the AOT treatment plan. Other categories of treatment that may be ordered but are not required include medication; periodic blood tests to determine medication compliance; individual, group, and/or family therapy; day or partial day programming; educational and vocational training or activities; alcohol or substance abuse treatment and counseling and periodic blood or urine tests for the presence of alcohol or illegal drugs for persons with a history of alcohol or substance abuse; supervision of living arrangements; money management; and any other services prescribed to treat the person’s mental illness and to assist them in living and functioning in the community.

Who is responsible for monitoring the AOT order?

The law mandates that a case manager or ACT Team be assigned the role of care coordinator. The care coordinator is responsible for monitoring the subject’s compliance or lack of compliance with the treatment prescribed in the final order. Each county must ensure that there is a mechanism in place for reporting compliance or lack of compliance to the county. The order requires the DCS to ensure that all categories of service that appear in the final order are provided to the subject.

Can a treatment provider change an individual’s medication when it does not appear in the current court order?

Ideally, contingency medications should be incorporated into the treatment plan and final court order. However, there may be situations where contingencies were not developed and medication needs to be adjusted. If the subject is in agreement with the medication change, there is no need to return to court for a modification of the final order. It would be important, however, to document the change and alert all treatment providers. Should a renewal of the order be sought subsequently, the court can be informed at that time of the change in medication.

What happens if the person does not comply with the terms of the court order?

If a physician determines that someone under an AOT order is non-compliant with the court order and may need involuntary hospitalization, the physician may arrange for the individual to be transported to a hospital and retained for an evaluation not to exceed 72 hours to determine if inpatient care and treatment are necessary. Any refusal of the person to take prescribed medication or the failure of a test to determine either medication compliance or alcohol or drug use may be considered by the physician in reaching the clinical determination regarding involuntary admission.Any decision to retain the person beyond the initial 72 hours must be in accordance with the procedures for involuntary admission set forth in New York State’s Mental Hygiene Law.

What happens if an individual under court order requires re hospitalization or is incarcerated? Does that time spent in the hospital or in jail erode from the court order?

The court order is continuous regardless of whether or not an individual is hospitalized or incarcerated. However, it cannot be enforced unless the subject of the order is in the community. Therefore, during a hospitalization or incarceration, the AOT order remains dormant. When the person is either discharged from the hospital or released from jail, the AOT order will resume. It will expire on its original expiration date, unless a renewal order is subsequently granted.

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